Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Todd Moore

Committee Members

Leticia Flores, Lora Humphrey Beebe, Kristina Kintziger


Research on HIV treatment has indicated there are numerous factors that contribute to medication nonadherence, and therefore, risk of transmission. Mental health issues, substance abuse, and co-occurring physical health issues have shown to have negative impacts on HIV medication adherence. Additionally, living in a rural area compared to an urban region negatively impacts adherence. African American males fare the worst in HIV treatment, having the least engagement with HIV care resulting in late stage HIV upon diagnosis, and are within a group that are at the highest risk of infection. Gender role socialization theory and research on male help-seeking behavior guides the current study that aims to investigate predictive factors and the intersection of these factors on HIV medication adherence. This theory states that males are less likely to seek medical and mental health care, or underreport symptoms. Participants were 133 Ryan White Part B clients who have received support and treatment for HIV for at least two years. A retrospective longitudinal design examined how intersecting factors predicted viral variability and CD4 counts in HIV-positive (HIV+) individuals. It was hypothesized that mental health issues, substance abuse, physical health comorbidities, region (e.g., South versus North), and race (e.g., African American/Black versus White counterparts) would impact viral variability and CD4 counts. Results showed that substance abuse, changes in urban/rural residence, and physical health comorbidities impacted viral variability or CD4 counts, and ultimately, substance abuse had the greatest negative impact. Implications of these findings can guide future research and clinical interventions for co-treating substance abuse and HIV.

Available for download on Tuesday, August 15, 2023

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